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penetrating cardiac injury

Joe Nemeth, Mr joe.nemeth at mcgill.ca
Sun Dec 20 13:50:50 GMT 2009

First off...Merry Christmas and Happy Holidays to all!

To the question:

2 nights ago....

20 y.o. stab wound to box...
On arrival BP 80/-....while 2 C/T are going in PC view shows the obvious...
C/T's put out nothing...BP 50/-
Clam shell done...identified obvious Rt. V. defect, achieved "finger hemostasis"...
BP 130/-...Surgeon arrives, pledgeted sutures placed...
Goes to OR...does very poorly after...
Actually sustained an interventricular septal wound as well with resulting Lt. to Rt. shunt...obviously not recognized earlier...

How many of your institutions have perfusionist stand-by/?in-house for urgent bypass in these cases?
Who among the trauma surgeons is trained to feel comfortable placing someone on bypass a opposed to calling in a cardiac surgeon?
Who has experience using adenosine to simplify suturing/stapling?


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